Pulsed Field Ablation as First-line Therapy for Atrial Fibrillation: A Substudy of the EU-PORIA Registry.

IF 9.1 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Circulation. Arrhythmia and electrophysiology Pub Date : 2024-11-27 DOI:10.1161/CIRCEP.124.013088

Anna Füting, Kars Neven, Stefano Bordignon, Tobias Reichlin, Yuri Blaauw, Jim Hansen, Raquel Adelino, Alexandre Ouss, Laurent Roten, Bart A Mulder, Martin H Ruwald, Roberto Mené, Pepijn van der Voort, Nico Reinsch, Thomas Kueffer, Serge Boveda, Elizabeth M Albrecht, Jonathan D Raybuck, Brad Sutton, Kyoung Ryul Julian Chun, Boris Schmidt

{"title":"Pulsed Field Ablation as First-line Therapy for Atrial Fibrillation: A Substudy of the EU-PORIA Registry.","authors":"Anna Füting, Kars Neven, Stefano Bordignon, Tobias Reichlin, Yuri Blaauw, Jim Hansen, Raquel Adelino, Alexandre Ouss, Laurent Roten, Bart A Mulder, Martin H Ruwald, Roberto Mené, Pepijn van der Voort, Nico Reinsch, Thomas Kueffer, Serge Boveda, Elizabeth M Albrecht, Jonathan D Raybuck, Brad Sutton, Kyoung Ryul Julian Chun, Boris Schmidt","doi":"10.1161/CIRCEP.124.013088","DOIUrl":null,"url":null,"abstract":"Background: Recent studies have demonstrated the benefit of early ablation in preventing the progression of atrial fibrillation (AF). Clinical practice has reflected this shift in AF management and no longer requires patients to fail antiarrhythmic drugs (AADs) before receiving ablation. However, there is limited evidence on outcomes with pulsed field ablation (PFA) as a first-line therapy. Examination of real-world data may shed light on clinical practices and the effectiveness of PFA with and without a prior history of AAD usage.Methods: EU-PORIA is an all-comer AF registry enrolling consecutive patients treated with the pentaspline PFA catheter at 7 high-volume centers in Europe. This subanalysis evaluates patients with a history of class I/III AAD use versus those with no documented history of class I/III AAD use (first-line patients). Patients with incomplete AAD history, long-standing persistent AF, and those undergoing a repeat ablation procedure were excluded. Patients were treated and followed based on institutional standard of care. Any episode of atrial tachycardia or AF lasting longer than 30 s was considered an arrhythmia recurrence.Results: Of 1233 patients enrolled in EU-PORIA, 1091 met the inclusion criteria (mean age, 66 years; 40% females; and persistent AF, 36%). Pulmonary vein isolation-only was used in 90% of the patients, and 10% received extra-PV ablation. Ablation as the first-line approach was chosen in 589 patients, and 502 patients had prior class I/III AAD use. In the first-line PFA group, paroxysmal AF was more frequent (68% versus 59%; P<0.001), and pulmonary vein isolation-only was more frequent (93% versus 86%; P<0.001). At 1-year follow-up, freedom from AF/atrial tachycardia recurrence was similar in the ablation-first versus the ablation after failed AAD group (78% versus 74%, respectively; P=0.076).Conclusion: In this large real-world PFA registry, freedom from AF/atrial tachycardia recurrence after 1 year was similar in patients undergoing PFA as a first-line treatment and those with prior failed AAD therapy.Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05823818.","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013088"},"PeriodicalIF":9.1000,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Circulation. Arrhythmia and electrophysiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/CIRCEP.124.013088","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Recent studies have demonstrated the benefit of early ablation in preventing the progression of atrial fibrillation (AF). Clinical practice has reflected this shift in AF management and no longer requires patients to fail antiarrhythmic drugs (AADs) before receiving ablation. However, there is limited evidence on outcomes with pulsed field ablation (PFA) as a first-line therapy. Examination of real-world data may shed light on clinical practices and the effectiveness of PFA with and without a prior history of AAD usage.

Methods: EU-PORIA is an all-comer AF registry enrolling consecutive patients treated with the pentaspline PFA catheter at 7 high-volume centers in Europe. This subanalysis evaluates patients with a history of class I/III AAD use versus those with no documented history of class I/III AAD use (first-line patients). Patients with incomplete AAD history, long-standing persistent AF, and those undergoing a repeat ablation procedure were excluded. Patients were treated and followed based on institutional standard of care. Any episode of atrial tachycardia or AF lasting longer than 30 s was considered an arrhythmia recurrence.

Results: Of 1233 patients enrolled in EU-PORIA, 1091 met the inclusion criteria (mean age, 66 years; 40% females; and persistent AF, 36%). Pulmonary vein isolation-only was used in 90% of the patients, and 10% received extra-PV ablation. Ablation as the first-line approach was chosen in 589 patients, and 502 patients had prior class I/III AAD use. In the first-line PFA group, paroxysmal AF was more frequent (68% versus 59%; P<0.001), and pulmonary vein isolation-only was more frequent (93% versus 86%; P<0.001). At 1-year follow-up, freedom from AF/atrial tachycardia recurrence was similar in the ablation-first versus the ablation after failed AAD group (78% versus 74%, respectively; P=0.076).

Conclusion: In this large real-world PFA registry, freedom from AF/atrial tachycardia recurrence after 1 year was similar in patients undergoing PFA as a first-line treatment and those with prior failed AAD therapy.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05823818.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

脉冲场消融作为心房颤动的一线疗法：欧盟-PORIA 注册的一项子研究。

背景：最近的研究表明，早期消融对防止心房颤动（房颤）恶化大有裨益。临床实践已反映了房颤治疗的这一转变，不再要求患者在接受消融术前服用抗心律失常药物（AAD）失败。然而，有关脉冲场消融术（PFA）作为一线疗法的疗效的证据却很有限。对真实世界数据的研究可能会揭示临床实践以及脉冲场消融术在既往使用过或未使用过 AAD 的情况下的有效性：方法：EU-PORIA 是一项全病例房颤登记，登记了在欧洲 7 个高容量中心接受五线 PFA 导管治疗的连续患者。本子分析评估了有 I/III 类 AAD 使用史的患者与无 I/III 类 AAD 使用史记录的患者（一线患者）。AAD使用史不完整的患者、长期持续性房颤患者和接受重复消融术的患者被排除在外。患者的治疗和随访均按照医疗机构的标准进行。任何持续时间超过 30 秒的房性心动过速或房颤均被视为心律失常复发：在加入 EU-PORIA 的 1233 名患者中，有 1091 人符合纳入标准（平均年龄 66 岁；女性占 40%；持续性房颤占 36%）。90%的患者只进行了肺静脉隔离，10%接受了肺静脉外消融术。589名患者选择了消融作为一线治疗方法，502名患者曾使用过I/III类AAD。在一线 PFA 组中，阵发性房颤的发生率更高（68% 对 59%；PPP=0.076）：结论：在这一大型真实世界 PFA 登记中，作为一线治疗接受 PFA 的患者和之前接受 AAD 治疗失败的患者 1 年后房颤/房性心动过速复发的自由度相似：URL：https://www.clinicaltrials.gov；唯一标识符：NCT05823818。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Circulation. Arrhythmia and electrophysiology 医学-心血管系统

CiteScore

13.70

自引率

4.80%

发文量

187

审稿时长

4-8 weeks

期刊介绍： Circulation: Arrhythmia and Electrophysiology is a journal dedicated to the study and application of clinical cardiac electrophysiology. It covers a wide range of topics including the diagnosis and treatment of cardiac arrhythmias, as well as research in this field. The journal accepts various types of studies, including observational research, clinical trials, epidemiological studies, and advancements in translational research.